This second of 4 reports in GAO's self-referral investigation covered anatomic pathology services between 2004 and 2010. Among the findings are that self-referred services more than doubled, while services referred externally increased far less (116% vs 38%); and spending was higher for self-referrals than for non-self-referral services (164% vs 57%). GAO estimated that the higher rate of procedures and higher number of services per biopsy by self-referrers cost Medicare $69 million. Additional findings and conclusions are in the report.

"There is more than enough evidence that self-referral leads to over-utilization," stated the Alliance for Integrity in Medicare (AIM) today in response to the report. GAO recommended that the Centers for Medicare and Medicaid Services (CMS) track self-referred anatomic pathology services, create policies to ensure appropriateness of biopsy procedures, and develop new payment approaches. AIM said that while it applauds GAO's findings, it disagrees with these recommendations. "It's time to get at the root of the problem and close the self-referral loop." APTA is an AIM member.

In its first report, GAO investigated self-referral in advanced imaging services, also concluding that financial incentives were a likely factor driving the increases in referrals and spending.

APTA anticipates the last 2 reports in the series, on radiation oncology and physical therapy, later this year.

Comments

This is intriguing given the current battle for AB1000 in California. CPTA is pushing POPTS along with direct access.

Posted by Tianna Meriage Reiter
on 7/19/2013 5:18 PM

With all the mounting negative evidence against POPTS and self-referral for profit. Why is CPTA voluntarily supporting a bill to legalize and legitimize these practices? It makes no sense to me.

Posted by Brian Stone
on 7/19/2013 7:30 PM

In light of this report, why is the California Chapter supporting a AB100 - a bill that supports POPTs??? AB1000 will significantly hurt private practice clinics in California even if direct access is available.

Posted by Debbie Struiksma
on 7/19/2013 8:47 PM

Isn't the most important information the number of pathologies found ?

Posted by Jana
on 7/20/2013 8:41 AM

This is just the tip of the iceberg. The local scam is for several MDs to form fake corp and open a DME, Hospice, and Rehab services, load them with fake claimes then split the profit. Several years later sell these business that are built on a house of cards for big bucks. The buyer now has a million dollar company with few referrals because these MDs have moved on.